dApagliflozin SC0062 and Prevention of Renal Injury; a Randomized Evaluation (ASPIRE-1)

University Medical Center Groningen (UMCG)

Status and phase: Not yet enrolling; Phase 2

Conditions: Type 1 Diabetes Mellitus With Diabetic Nephropathy

Treatments: Drug: SC0062 and dapagliflozin; Drug: Dapagliflozin (Forxiga®); Drug: SC0062 strength 10mg

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT06072326

2023-504404-28-00 (EU Trial (CTIS) Number)

17042

Details and patient eligibility

About

The aim of this study is to test the hypothesis that dapagliflozin (SGLT2 inhibitor) and SC0062 (ERA) combination therapy augments nephroprotection and mitigates fluid retention and ketogenesis in people with T1D through complementary and synergistic mechanisms of actions.

Full description

A phase 2, multicenter, randomized, open-label, cross-over trial will be conducted in male or female individuals (N=36) diagnosed with type 1 diabetes at least 6 months prior to informed consent aged between 18 and 65 years, Body Mass Index (BMI) ≥ 21 kg/m2, urinary albumin: creatinine ratio ≥ 50 mg/g and < 3000 mg/g, eGFR > 30 and <90 mL/min/1.73 m2 and HbA1c > 6.5 and <10.5%. Patients have to be on stable RAAS inhibition for at least 4 weeks prior to screening.

The study will consist of a screening visit, a 4-week run-in phase. After the run-in phase, the participant will be randomized to treatment of SC0062, dapagliflozin, or their combination in random order. The duration of each treatment period is 4 weeks with study visits scheduled at 2 and 4 weeks in each treatment period. At the end of each treatment period patients proceed to a 4 weeks wash-out phase to study off drug effects. The total duration of the study for each participant after randomization is thus 24 weeks

Interventions SC0062 10mg twice daily (20mg/day); dapagliflozin 5mg once daily; combination of SC0062 10mg twice daily and dapagliflozin 5mg once daily.

Enrollment: 36 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Willing and able to sign informed consent

• Male or female individuals diagnosed with type 1 diabetes at least 6 months prior to informed consent

• WOCBP must have a negative pregnancy test at screening and must not be lactating.

• Male individuals must use highly effective method of contraception for the duration of the study (from the time they sign consent) and for 4 weeks after the last dose of study medication, or be able to provide proof of vasectomy.

• Female individuals must use highly effective method of contraception for the duration of the study (from the time they sign consent) and for 4 weeks after the last dose of study medication, provide proof of hysterectomy or sterilization, or be deemed menopausal based on a FSH-test.

• Age ≥18 and <65years, at the time of signing consent.

• Body Mass Index ≥ 21 kg/m2

• Urinary albumin:creatinine ratio ≥ 50 mg/g and <3000 mg/g

• eGFR ≥30 and <90 ml/min/1.73m2

• Stable RAAS inhibition medication for at least 4 weeks prior to screening

• HbA1c ≥6.5 and <10.5%.

• Based on the Investigator's judgment participant must have a good understanding of his/her disease and how to manage it, and be willing and capable of performing the following study assessments (assessed before randomization):

  • patient-led management and adjustment of insulin therapy
  • reliable approach to insulin dose adjustment for meals, such as carbohydrate counting
  • reliable and regular home-based blood glucose monitoring
  • established "sick day" management regimen

Exclusion criteria

• Diagnosis of type 2 diabetes, or other types of diabetes (e.g. LADA).
• Treatment with an anti-hyperglycaemic agent (e.g., metformin, alpha-glucosidase inhibitors, pramlintide, glucagon-like peptide receptor agonist, etc.) within 3 months.
• Occurrence of severe hypoglycaemia involving coma/unconsciousness and/or seizure that required hospitalisation or hypoglycaemia-related treatment by an emergency physician or paramedic within 3 months.
• Hypoglycaemia unawareness based on Investigator judgement or frequent episodes of unexplained hypoglycaemia (2 or more unexplained episodes within 3 months).
• Occurrence of diabetic ketoacidosis within 6 months prior to study enrolment.
• Acute coronary syndrome (non-STEMI, STEMI and unstable angina pectoris), stroke or transient ischemic attack within 6 months.
• Any other clinical condition that, based on Investigator's judgement, would jeopardize patient safety during trial participation or would affect the study outcome (e.g., immunocompromised patients, patients who might be at higher risk of developing urinary, genital or mycotic infections, patients with chronic viral infections, etc.).
• Treatment with an SGLT2i within 30 days of Visit 1.
• NT-proBNP > 600 pg/mL
• Hemoglobin < 90 g/L
• Diagnosis of severe edema (per investigator judgment) within 3 months of screening
• Diagnosis of heart failure (NYHC stage III or IV).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

---

36 participants in 6 patient groups

Treatment order 1

Experimental group

Description:

Subjects will start with 4 weeks of SC0062 in treatment period 1. In period 2 subjects will receive dapagliflozin. In period 3 subjects will receive a combination of SC0062 and dapagliflozin. Between treatment periods there is a 4-week wash-out.

Treatment:

Drug: SC0062 strength 10mg

Drug: Dapagliflozin (Forxiga®)

Drug: SC0062 and dapagliflozin

Treatment order 2

Experimental group

Description:

Subjects will start with 4 weeks of SC0062 in treatment period 1. In period 2 subjects will receive a combination of SC0062 and dapagliflozin. In period 3 subjects will receive dapagliflozin. Between treatment periods there is a 4-week wash-out.

Treatment:

Drug: SC0062 strength 10mg

Drug: Dapagliflozin (Forxiga®)

Drug: SC0062 and dapagliflozin

Treatment order 3

Experimental group

Description:

Subjects will start with 4 weeks of dapagliflozin in treatment period 1. In period 2 subjects will receive a combination of SC0062 and dapagliflozin. In period 3 subjects will receive SC0062. Between treatment periods there is a 4-week wash-out.

Treatment:

Drug: SC0062 strength 10mg

Drug: Dapagliflozin (Forxiga®)

Drug: SC0062 and dapagliflozin

Treatment order 4

Experimental group

Description:

Subjects will start with 4 weeks of dapagliflozin in treatment period 1. In period 2 subjects will receive SC0062. In period 3 subjects will receive a combination of SC0062 and dapagliflozin. Between treatment periods there is a 4-week wash-out.

Treatment:

Drug: SC0062 strength 10mg

Drug: Dapagliflozin (Forxiga®)

Drug: SC0062 and dapagliflozin

Treatment order 5

Experimental group

Description:

Subjects will start with 4 weeks of a combination of SC0062 and dapagliflozin in period 1. In period 2 subjects will receive SC0062. In period 3 subjects will receive dapagliflozin. Between treatment periods there is a 4-week wash-out.

Treatment:

Drug: SC0062 strength 10mg

Drug: Dapagliflozin (Forxiga®)

Drug: SC0062 and dapagliflozin

Treatment order 6

Experimental group

Description:

Subjects will start with 4 weeks of a combination of SC0062 and dapagliflozin in period 1. In period 2 subjects will receive dapagliflozin. In period 3 subjects will receive SC0062. Between treatment periods there is a 4-week wash-out.

Treatment:

Drug: SC0062 strength 10mg

Drug: Dapagliflozin (Forxiga®)

Drug: SC0062 and dapagliflozin